Home Again

I just returned from a quick visit to North Carolina. I had not been back since I left almost 9 months ago. My best friend completed her PhD and is moving to Washington DC so I figured that I should get down and visit her one more time while she is still a local. It was so nice to visit old haunts like the Loop for a milkshake and Carolina Brewery all decked out in Carolina Blue for the first football weekend. It is so nice to know where to go and how to get there and have places to go! A weekend cookout, visiting with friends, bumming around the mall...a little hint of my former southern life.
I was able to make a quick visit to the hospital and see my weekend crew...both shifts with a 1830 arrival! The time went to quickly and I wish I had been there for a week day visit. It was good to see everyone and get a quick update about life in the CCU. Little equipment things were different...computers everywhere, e-charting-good, bad and ugly, and a new table in the break room. The most caring people are still there and that is the important thing!

New Year on June 26th!

I know that June 26th isn't typical for a New Year celebration but in the academic medical field this is the day when the new doctors freshly released from medical school start their hands on 'practice of medicine'. I can relate to the newest residents as I was in their shoes 6 months ago, the difference is that I started alone and there is a whole class of newbies who are all new together. I am well aware of most of the systems at this time and got to share some helpful hints for survival on their first day at work.
I gave them the Super Doc extension (the Bed Commander's arch nemesis), showed them how to order labs so they are done properly, and showed them how to flag an order to be taken off. Simple tasks that just need to be passed along. Too bad there are no second year residents to show them around and the fellow never writes orders so there is little help there... I get to help them as much as possible, and it reminds me how far I have come in 6 months! Yeah. We shall see how day two goes!

Busy Week

My brother came for a visit this past weekend before he starts graduate school (his second time around). His program is an intensive 363 day program at Union College for which he will acheive a master's of arts in teaching. I figured that this past weekend was the last time he would get to be away and not have homework to do! We had a nice time exploring the Lebanon/Hanover area and checking out some local eateries. We hiked at Quechee Gorge and we got to meet lots of people at church. I am always amazed at how friendly folks are here.

I hiked Mt Cardigan on Wednesday with some coworkers. We left after work (hiked up about an hour at my pace) and were able to watch the sunset through the clouds. The view was spectacular and I am told it is the best view for your hike in the area. It was a full moon that night but the clouds blocked the view so the moonlight hike will have to be post poned until next month. It may be summer but you still need coats and hats on the top so I guess that my winter wardrobe can't be put away just yet.

Kristy and Ed had their baby on Monday, (for reference my bridesmaid dress was highlighter green). Sienna Sofia arrived at 3:08pm on June 16th. Mom and baby are doing well and they are all home now. Sienna didn't have a name for two days, which is ironic since her mother has had a baby name list since before I met her 12 years ago! Sienna has a head of dark hair and blue eyes in the photos I have seen so far. Her mother is amazed at her hair color but I remember when she wasn't a blonde... Her name reminds me of the burnt sienna crayon I used to use in my 64 count crayon pack, so I have gathered together a crayon bouquet to give to Sienna later today.

A couple of college friends will also be in Boston today so it will be a nice reunion of sorts and we will all get to meet Sienna. I can't wait to meet her!

Home Sweet Home

Home Sweet Home for the past four and a half years is now under contract for someone else to call it home. After 5 months of multiple viewings a couple is interested and an offer to purchase is completed. Now the fun begins....home inspection.... closing dates.... and all that fun. It so far has been much less stressful selling than buying. But we will see if that holds true through the rest of the process. But then I have had a winter home and a summer home for 5 months so it will be nice to be down to one residence!! Yeah!!

Driving Round

So I was driving down the road last week on my way to Manchester NH and as I was zipping down the highway and there was an unusual finding....a wild turkey smack dab in the middle of the road! I zipped by him and ruffled his feathers a little. The car I had just passed caused him to zip across the road. Just another reminder that I truly live in the great north woods.

As I moved to NH my car passed 100,000 miles, and now that I am able to attend all the spontaneous celebrations by driving I find that I am often on the road many weekends. . I have been to Portland Maine twice, the island of Manhattan once, home to my parents twice, CT once, Boston twice, Burlington Vermont twice, Essex Junction VT, and Waterbury VT. I have cris crossed the northeast almost every weekend. However, I have been to four birthday celebrations in four different states, one visit to welcome a friend from Carolina to Boston, a chocolate festival, Ben & Jerry's factory, Easter and a shopping trip for professional dress work clothes. How I miss the non-thinking scrub days!

I had my first visitors up from Boston...Kristy and Ed came up to NH last weekend. We walked around Hanover, saw a native American exhibition, walked the bridge across Quechee Gorge, and had ice cream at a service station that boasts 55 flavors. It was quite the afternoon excursion. Since they are expecting in 4 weeks it is probably the last time we will have a quick tour around without any baby items!

Traveling

I found the above map and decided that 7% isn't a bad place to start but I have some decidedly bare spots on the map. If we were going by land mass then I am doing pretty well thanks to Russia. Once my 'summer home' in NC is sold then I will have to work on coloring in some more of the countries, after I get a new passport that is!

Today I traveled to Burlington VT for a little shopping and people watching. I reconnected with my cousin who lives nearby and we had a great afternoon trading stories from the last 12 years since we saw each other. It is weird hanging out with someone who answers to your last name. At dinner it was just like being in the basketball unit in gym class. Go Jones! Yeah Smith. Over here Stender! Too funny.

Two inches of snow received yesterday for the flurry count
April 4th and still snowing. ****** Beautiful but a little late for two inches!
Then the rain washed it away. However, today I didn't even have to button my jacket so there is some spring weather progress!

Flurry Count

Spring is officially here however the snow flurries are still greeting me each morning. The good thing is that the ground has warmed up and the snow is not sticking to the ground anymore. I believe that I will keep a flurry count of how long I see flurries into the spring/summer months. A patient's family member suggested June and if that is the case then I might need to return to the hot summers of NC before long!
Today my patient gave me a kiss on the cheek when I let him know that his son was in the loop with our plans. This after he heard that he had three vessel disease and may need surgery. People will never cease to amaze me! It is nice to be appreciated for the little things that we do for one another even if it is part of the job.
I had dinner with some fellow nurses tonight at the Mexican restaurant here in town. I don't know that any Mexican has darkened the door of the restaurant however I can tell people think that they are eating ethnically. I seem to eat there at least once a week and the minute that I walk in and someone greets me by name then I am out of there! In my weekly trips to the local joint...I have discovered that it is ladies night there every Thursday. Amazing. 40% off your meal in the bar area if you are a lady! What a deal. I am surprised that every Dartmouth coed isn't hanging out here for the bargain meals which aren't cafeteria food! Anyway I might need to make my weekly trip on Thursday after all (plus the Carolina game was on last week which was an added bonus!)

What a Week

It is official.... This winter is the second snowiest on record in NH. See the chart below for the details. Of course the six or more inches we had last night helped!

Snow Totals (10:45 a.m.)

1. 122" 1873-1874
2. 115.2" 2007-2008
3. 115" 1872-1873
4. 113.2" 1995-1996
5. 111" 1886-1887
5. 111" 1887-1888
7. 103.2" 1898-1899
8. 103" 1874-1875
9. 100" 1875-1876
10. 100" 1971-1972

There were lots of new things I got to do at work yesterday! I did my first comfort measures only order set, I had a my first family meeting that I started, I had my first family that refused to come when I called them about the dire situation of their family member. I ordered my first DNR and palliative care consult and I had my first four point restraint patient. As I was the restraint queen at UNC it was a whole new experience at a new hospital who is not so clear about their restraint process! I had my first interpreter needed patient (French of course being close to the Canadian border). I attended my first ladies night...by chance as it was my coworker's 35th birthday and we needed to celebrate. The Mexicans restaurant, that no Mexican has ever attended, has 40% off your meal when you come on Thursday for 'Ladies Night'. What a perk that I might have to take up again. The UNC basketball game was even on for a little bit and the waiter was sweet talked into changing it from boxing. Ugh. Needless to say I was exhausted when I got home.
I have always enjoyed end of life care as I feel that if it is done well it can be a comforting experience for families on one of the worst days of their lives. I did miss being at the bedside and when the son didn't recognize me later in the day as being the person who called him in and then held the family meeting I won't lie that it didn't hurt a little bit. Being one person removed from the bedside is a tough adjustment to make at these times. However, this morning the family was nothing but thankful for the care provided and they only had good things to say about our care on the day that their father died. I take a good deal of pride in that fact even though I didn't perform any of the mouth care or turn the patient.
I was so focused on providing good end of life care that when the family member asked me a question I completely misunderstood him. He said that the dying room closed at 7:30pm. I asked him "Dying room?" He said yes and I stated that I didn't know that we had one. The palliative care NP had just left the room so I figured that I was new and didn't know about this service we offered. I went to ask one of the nurses about the 'dying room' and she didn't know about this ... then I called the case manager and she said "dining room?" then I realized the patent's family member meant DINING ROOM as in CAFETERIA. Ugh. What a dork I can be but I was so focused on the end of life care that the nutritional needs of the living slipped my mind. Too funny.
I brought my yearbook into work to compare with my attending who also attended my h.s 20 years previously. Of course he forgot his and mine was there for every one's enjoyment. The nickname under my Senior photo, the Most School Spirit award (my coworkers believe that I was a cheerleader and just won't fess up! The idea!), and of course the prom photo! It was giggle at Janette day all day long, as well as a walk down memory lane! Perhaps I will start a trend and other yearbooks will show up next week, but I doubt it.
Shower for Lindsay is tomorrow! Ladies lunch is a better description...complete with cake and favors but no bridesmaids! It will be a nice time for Lindsay to be with her friends and family.

New England Charm

I have exciting news to share. I have left work on time for three days in a row this past week! Hurray! I can't say that it is all my doing...there were no snow storms this week to set off a barrage of heart attacks that occur while shoveling snow. However, after being here for two full months it is great to see blue sky when I left work. Spring must be around the corner. I know that the clocks change this weekend and it will be dark again when I leave work but it has been so nice these past two weeks to wake with bright skies and see the sun again when I get out of work.
Tonight I spent my dinner chatting with some girlfriends and planning a wedding shower. My spring wouldn't be complete unless I was planning a wedding shower!! My good friend Lindsay is getting married ... on a cruise ship... just her and her fiancee. Each life event we can celebrate should be enjoyed in fine form. So celebrate we will... that no one is wearing a dress they will detest and will whine about for months (Lindsay herself is quite proud of this), no one is stressing about the wedding details (that is what a cruise wedding director is for!), no one spending a small fortune for a party (when there is a house down payment to save for!) and the fact that Lindsay found the love of her life (the wedding is four weeks away and she is on cloud 9). So celebrate we will at a small luncheon. Just the women in Lindsay's life getting together for lunch to laugh together, share fond stories of Lindsay and Shawn and eat yummy Italian food (one of Lindsay's favorites). Not to worry that there will be favors and gifts and cake of course! If only I had a favorite cake lady (such as The Chocolate City caterers) here in NH.
Here is the northern charm items I learned about this week...
-The bumps in the road that occur after the worst of the winter weather is gone are called 'frost heaves' Every NH town has signs that say Warning Frost Heaves. This means that they don't have to fix the roads for another 3 months while the signs are posted.
-Vermont is often said that it has the most charm of all the New England states. As I drove through a covered bridge last night I had to agree. How long have people been using that bridge? From horse and buggy to SUV-what a classic touch to typical travels. Vermont even has a Covered Bridge marathon to celebrate their unique. If you are in Quechee VT go to Simon Pearce glassworks (amazing restaurant and glassware) and you will get to visit the same beautiful covered bridge. Ahhh. The photo above is the Simon Pearce restaurant on the Quechee Falls.
I am off to Boston for some quality time with some college girlfriends. A full day of shopping, talking and revisiting all of our old haunts will let us relive some of those college moments (with a one year old this time....) Now if I can beat the freezing rain that will be descending upon us...

Old Home Week!

It has been so nice to hear from all the North Carolinians this past week. It is hard to move away from people you grew to care about and start over. Dartmouth has some big shoes to fill in the coworker department that is for sure! I only have three coworkers now so it is quite the different dynamic. Please keep up the newsy tidbits!

I was able to see my friends in Maine last weekend meet their daughter Elizabeth for the first time and take her mother out to see 27 Dresses. Much to everyone's surprise the movie was not based on my life :) Mom's of 9 month olds don't get to go out to the movies very often so I was happy to take her out on the town. Elizabeth was very cute and so friendly. I got to keep her occupied while her mom made dinner. She was memorized by anything shiny ... funny how girls like pretty shiny things at any age! I also got in touch with some college friends. It is

I have decided that the Patriots do best when I am in North Carolina, as that is where I have been for all their past super bowl wins. I will have to remember that for the future games. Last year I made my super bowl cake and introduced the CAKE to the CCU crew. In fact I had to make two cakes last year...one for work and one for my friends. This year I made the cake but there was just two of us to share it. One of my neighbors came over and watched the game with me. I have lots of cake left over.... but as the players are so tasty that shouldn't be a problem.


Work is going better I believe. The attending changes each week so just when you get to know what they like they are done with their rotation. They certainly work hard for the week they are with us. They go all out for that week so it is hard to match their intensity each and every day while learning. Someday it will be nice to know what I am doing without having to double check each and every moment. It would be nice to zip through this learning period but it is not to be for a while yet. Ugh.

I had dinner with Lindsay tonight. She did her taxes and I left work at 6pm which is the typical time for leaving no matter that I am done with my work at 5pm. There is always one more thing for me to double check so that I will be able to sleep at night without too much anxiety. It is so nice to know someone from my life before who understands the hospital culture shock and now that she works with me on the floor I get to relive our UNC days where we worked together.

There is another big game in my life this week. UNC vs Duke is Wednesday and I am going to have to search out the game on television. Of course Wednesday is the day that my coworkers and I are going out for Mexican. (Or the NH version of Mexican food...I should say). I will have to remember to wear my Carolina Blue so that the Duke NP knows the score. My tarheel pin is on my white coat so the entire world knows who I am cheering for!! Go Heels!

I learned something today that may prompt me to write a letter to the lawmakers in VT. I was told that the truck drivers with CDL (commercial driver's license) are UNABLE to take insulin. So my poor diabetic patients who have HgbA1C levels of 8.6 and are maxed on oral meds are sacrificing their health to keep their livelihood. I am going to have to investigate this information that was passed on to me and write a letter to someone. At least VT has a good prescription plan for those who don't have coverage so no one is completely uninsured. I am learning the nitty gritty about NH and VT. It all depends on which side of the river you are standing on....

I am going to Connecticut this weekend to celebrate my brother's birthday with the rest of my family. It will be nice to get together for this life celebration....now I just have to find a birthday gift tomorrow. Perhaps I will zip up to Burlington VT or visit the Vermont Country Store. and see what there is to find.

Another Week Down

No one who knew me in the South would believe it but I am positively WARM everyday at work. I used to have to wear sweatshirts and long sleeved shirts to work everyday including the summer months. At home in NC I was often found underneath a down blanket and my thermostat was set at 76 degrees year round. Now in NH the temperatures are near zero outside and yet I was able to wear a short sleeved shirt and stay quite toasty! My thermostat is set on 70 and that is the high! I am not running around anymore at work so I can't explain the temperature flip that I seem to have undergone.

I have a different role now in my patient's life. I am no longer in charge of every thing that goes on in the patient room. In the CCU if anything was going on with my patient I knew about it or what went on went through me. Now I am involved in my patient's life in a more indirect way. I write the orders but am not standing at their bedside to see that they are carried out. For the controlling ICU nurse in me it is difficult to let go of some of the patient care tasks that I so enjoyed. However, I need to adjust to my new role and trust in the nursing team that is at the bedside.

Three patients have sincerely thanked me for my care upon leaving. They mentioned that they felt very safe with me as their nurse practitioner. For this new NP that is the best feedback I could receive.

Tomorrow I am going to watch the movie that I have been told is based on my life as a bridesmaid...27 Dresses. I am even going to be joined by one of my former brides so it will be a fun afternoon for both of us...even if I have to travel to Maine to do it!

Work has begun, sleeping in is over

I am two weeks into the job and there is so much to take in. No computer provider order entry for one thing. Hand written orders in triplicate is so out of mode but it is what we do. It is said that POE is coming but I guess that has been the rumor for the past couple years. I am destined to begin jobs where there is no POE and by the time I leave it is there. Does that make me the POE fairy godmother.

The caliber of the attendings is wonderful and their teaching on rounds has been outstanding. I learned so much yesterday...now I have to look up so much stuff this weekend. I have good supportive people around me. Another NP was hired for our team and she started a month before me. She has been a NP for 4 years but she was in a clinic doing internal medicine so cardiology is all new to her. I am new to being a NP so we are a match set when you put us together. I have really enjoyed taking care of my patients and they really are MY patients. I make their consults, write the orders and make their follow up appointments.

We type EVERYTHING. H&Ps, daily notes, discharge summaries so my typing is bound to improve more than I ever thought possible!! I am finding learning all the systems too slow for my own liking, but there are so many of them. I will get it... I just want to get over the novice period as soon as possible. My friend Lindsay who used to work at UNC is here and works as one of the care coordinators (arranging VNA, rehab, meds for folks without money). It is nice to know that there is a friendly face here if needed.

One of the attendings went to my high school and had a biology teacher that was still there when I went through (although I didn't have him it but the other biology teacher). One of our pharmacists is married to someone who was a year behind me in school. I am so used to working in areas where I am anonymous that it is weird to have people know my hometown or even know me!!

I have my first official business card as a NP but am still waiting for my white coats. I am still wearing my horrible poly-blend coat from clinical. It is so gross even after soaking it in OxiClean all last weekend.

My parents are here this weekend for a visit (and have taken me out to dinner twice!) It is nice to be close to home and my parents don't have to arrange this trip weeks in advance. The snow is looking beautiful again so any and all takers are welcome!

On the Floor

My new home away from home (minus the 2 feet of snow)... :)



I survived my first day on the floor. It is a lot like traveling to a foreign country. There is so much to take in...new people, the environment, the systems. The day starts shortly after 7am and continues until the work is over. As most of the admissions are transfers and they come at all times there will be no 'typical' day. My preceptor is currently tackling two of us that are new to the service. I feel bad that I can't help her more but I don't know what to do and as it is the first day I am just short of useless. I met nurses, case managers, pharmacists, and physicians. Everyone is less formal that I expected. Patients call their doctors by first name so not only do I need to know last names but first names as well. Let the quizzing begin, perhaps flash cards would be beneficial. I just hope that most folks wear their name tags.
I received my technology... beeper, computer, and phone. Now to only learn how to use all the computer programs. The system is windows based so that is helpful but not the easiest to use. The more I use it the better it will be I just need to remember that it will be frustrating for a little while until I have everything formatted to my liking.
I wrote my first H&P but no orders yet. The first patient had Flolan infusing (a drug used for pulmonary HTN) which is not a favorite of mine. If the IV infusion is ever stopped the rebound hypertension in the lungs can be fatal. It isn't exactly a benign easily administered drug. My patient was admitted with it already infusing so I just had to treat it as one of her normal meds like aspirin or prilosec. Yikes. Thankfully my preceptor handled the orders and setting up the hospital infusion so I could focus on the note. I left after 6pm so the 10 hour day is more of a guideline than actuality. The service went from 13 patients to 25 and it is only a 32 bed unit. Talk about a crazy day to try and get acclimated. At least I could say that it was my first day and I didn't know what exactly was going on .... I don't think that saying that it is my second day is going to excuse me from anything. It was a one day only deal. Now I just need to catch up and learn the system as best as possible.
An attending grew up in my hometown and went to my high school. The pharmacist's wife was a year behind me in school. I am so used to working in an environment that is completely anonymous. No one knew my hometown, or me in any of the places I used to live. As my friend Paul would say...'interesting'. Hopefully I can represent my self, my hometown, and all the people and places that have had an impact on me in a positive light.
If you are ever traveling in New England in the winter and you see a little building on a trailer I will explain what it is... The building is so small that it would be barely big enough to contain a lawn mower if it was called a shed. No this building can't even be called a shed, it is a shack. A shack on wheels being carefully transported to the next available location. Why move a shack... it is an ice fishing shack. The only structure that will prevent the cold breeze across the lake from turning you into a popsicle. Brr.

2nd Day

I got TONS of paperwork to review 'at my leisure' today. There was only two providers starting today and we had completely separate sessions. That means that I had an individual meeting with the coding, billing, and benefits people. Talk about one on one attention to welcome you!

I did get my email address and had an orientation to the computer system used for patient documentation. I get my beeper, laptop and will have my lab coat fitting tomorrow. Scary...lab coat fitting. I usually just buy the least offensive polyester one that I can find maybe I can get one in cotton.

I am off on Friday and Monday. The scheduler counted my two orientation days and the holiday so only one more day of work this week before a four day weekend. Who knows when this will happen again so I had better enjoy my extra long weekend. I will be following my preceptor's schedule for a little while until I get a little grip on the system.

I have a desk in the office with a window view (of the main roof). It took my Dad 20 years to get an office with a window so I hope that he won't be too jealous. The only drawback is that I have no direct shelf space above my head but there is space on the side wall and that is completely ok with me. There is another new NP who started two weeks ago so there will be two newbies. She is experienced as an NP but is new to cardiology. I am old to cardiology but new to being an NP so hopefully we will balance each other out. My coworkers have been really friendly and seem quite dedicated. I will be working on the floor and with the patients starting tomorrow.

I have my stethoscope, pocket guides, and calipers ready to go. My lab coat is hanging over my rocking chair (which used to sit on my porch and now is in my living room as there is no porch in NH!)

NH broke it's December snowfall total of 44 inches in Concord. It is the most snow in December since they started keeping track. And I am loving it! Let it snow, let it snow!

New Year New Job

Happy 2008! Celebrating a new year wasn't enough this year so I am celebrating a new career as well. I have been attending hospital orientations in various forms since I was 14 where I was wearing a red and white striped jumper (yes the standard candy outfit). Off the top of my head I have attended at least five hospital orientations. and have sat through at least five that I can recall. Today's was no different. Wear gloves, recycle, shred patient information, however there were some interesting tidbits that I learned:

• The closest hazardous material landfill is North Carolina.
• The chemotherapeutic/radioactive landfill is located in Ohio. (I guess these state residents lost the Not In My Backyard fight.)
• The hospital creates 6 tons of trash daily.

Boy am I glad that we recycle over 30% of the trash. I moved from a town that was renown for its recycling and a hospital that barely recycled, to an apartment complex that doesn't recycle and the hospital is leading the nation with its reuse/recycle/reduce efforts. As my friend Paul would say, "Interesting." After so many hospital orientations I must admit that this is the first one that had an entire 30 minutes donated to discussing trash.

Another interesting fact....in the code of conduct we are instructed to not call patients by their first names unless invited to do so. This is the way I grew up and thought it was just a regional custom however here it is in the hospital manual. I would like to believe that this won't be a problem for me as this is the way that I was raised (Some neighbors that I have known for 25 years are still Mr and Mrs. despite my trying to use their first names but it is too weird). However, I must admit although I kept my northern accent mostly intact, I did slip into the "Hey honey/darling" habit. "Hay is for horses" so the sing songy He-ay stretched over two syllables I used to greet coworkers with (after 0800) needs to come to an end. I will be working with a former UNC coworker here in NH so she will be able to support me through these regional differences.

I had agonized about my orientation outfit. The overriding question... Will I be cold? (which is always a driving concern of mine no matter where I live...hence the number of turtle necks and pairs of long underwear in my closet :) Is there too much snow to dress up (a fresh five inches was on the ground this morning)? Should I dress up as I will be sitting most of the day and cute shoes are better for sitting than standing? I should not have worried so much as to what I was wearing as some of the department chairs that spoke to newbies today were wearing jeans, fleece vests and the majority were wearing boots! The dress code is nice and relaxed here in NH and seeing as though the closest Ann Taylor is 76 miles and the closest Loft is a state away it is nice to know that I shouldn't have worried. (I did wear a cowl neck sweater and was quite warm sitting in class all day! Ahhh.)